EHR vendor NextGen to pay $31 million to settle False Claims Act allegations

The settlement comes after the Supreme Court in June ruled that FCA defendants are liable for claims they suspect or knowingly believe are false.

By Brian T. Horowitz • July 17, 2023

CMS floats 1.25% physician fee cut, 2.8% outpatient bump in new proposed rules

Regulators also proposed stricter price transparency requirements on hospitals and expanded behavioral health payments in Medicare.

By Sydney Halleman • July 14, 2023

Kraft Heinz sues Aetna, says insurer breached ERISA fiduciary duties

Aetna wrongly retained millions in undisclosed fees and paid provider claims “that should have never been paid,” according to the lawsuit filed in a Texas federal court.

By Ryan Golden • July 13, 2023

States’ varying approaches complicate effort to determine impact of Medicaid redeterminations

Millions of people have been disenrolled from Medicaid, but it’s too early to get a full picture of redeterminations’ effect on vulnerable Americans, experts say.

By Emily Olsen • July 13, 2023

First nonprescription birth control pill approved by FDA

The oral contraceptive’s maker, Perrigo, said the pill will be available in drug and grocery stores early next year, but did not disclose its planned price.

By Delilah Alvarado • July 13, 2023

CFPB urged to abolish deferred interest amid medical debt concerns

Panelists who spoke during a recent hearing on medical billing and collections identified deferred interest credit cards as a prime culprit saddling patients with medical debt.

By Caitlin Mullen • July 13, 2023

CMS faces poor data quality in payment model health equity push

Variable race and ethnicity data is making it difficult to determine whether CMS Innovation Center models are reaching, enrolling and helping underserved beneficiaries, according to a new white paper from the agency.

By Rebecca Pifer • July 12, 2023

Feds drill down on medical cards

With consumers increasingly tapping medical credit cards to pay for healthcare costs, the Biden administration is zeroing in on regulations to police such financial services.

By Lynne Marek • July 10, 2023

Judge throws out class action lawsuit against Teladoc

A New York judge ruled that Teladoc had detailed risks of its $18 billion Livongo acquisition and that, while the company may have been optimistic regarding its operations, it did not falsify facts or statements.

By Brian T. Horowitz • July 10, 2023

CMS to return $9B to 340B hospitals under new plan

Hospital groups said the proposed rule is an important step toward restitution for years of 340B underpayments, but they criticized regulators for proposed rate decreases and a lack of additional interest payments.

By Rebecca Pifer • July 10, 2023

Home health industry group sues CMS, HHS over payment cuts

The National Association for Home Care and Hospice said regulators used “an illogical and invalid methodology” in a new payment model.

By Emily Olsen • July 7, 2023

Biden admin rolls back Trump-era expansion of short-term health plans

The proposed rule released Friday would limit short-term plan duration to up to four months. Stakeholders have been waiting for President Joe Biden to restrict access to the bare-bones coverage since he assumed office.

By Rebecca Pifer • July 7, 2023

FDA grants Eisai’s Leqembi full approval, opening door to wider use of Alzheimer’s drug

The broader approval is expected to push insurers, namely Medicare, to increase coverage of amyloid-targeting therapies.

By Jacob Bell • July 6, 2023

Patients continue to utilize telehealth for mental healthcare: Fair Health

Stakeholders await final post-pandemic telehealth guidelines after mental healthcare utilization increased during the COVID-19 pandemic.

By Susanna Vogel • July 6, 2023

More funding for cultural outreach is imperative to curb procedural Medicaid disenrollments

Investing in appropriate outreach as states resume eligibility checks is both humane and economically efficient, argues Jackie Leung, a public health researcher and professor at Linfield University.

By Jackie Leung • July 6, 2023

FTC intervenes to correct Medtronic’s ‘erroneous assertions’ in antitrust case

The FTC filed an amicus brief because it said Medtronic made “wrong” arguments with “broad implications for antitrust enforcement.”

By Nick Paul Taylor • July 6, 2023

Georgia’s Medicaid work requirements pricier, more restrictive than full expansion

By only enacting a partial expansion, the state is forgoing $1.1 billion in federal funding and harming access to coverage, according to a new report.

By Rebecca Pifer • June 30, 2023

SCOTUS affirmative action ruling sets back physician diversity efforts, healthcare groups say

Medical leaders including the HHS argue the ruling against race-conscious admissions policies could roll back gains in the number of minority physicians and ultimately hurt health outcomes.

By Emily Olsen • June 29, 2023

DOJ charges dozens in multiple states for $2.5 billion healthcare fraud

The multi-state bust that targeted 78 individuals represents “one of the largest healthcare fraud schemes ever prosecuted by the Justice Department,” Attorney General Merrick Garland said.

By Susanna Vogel • June 29, 2023

MA beneficiaries with chronic conditions have lower utilization, spending, industry-backed report finds

The Better Medicare Alliance-funded analysis compared beneficiaries with hypertension, hyperlipidemia and diabetes across MA and traditional Medicare and found that spending was “consistently higher” among FFS beneficiaries.

By Emily Olsen • June 28, 2023

State legislatures around US grapple with how to handle nursing shortages

At least 18 states have introduced or advanced safe staffing bills this year in an effort to reduce nurse burnout and improve the quality of patient care, but hospital groups are resisting.

By Susanna Vogel • June 28, 2023

HHS finalizes info blocking penalties for IT vendors, kickstarting enforcement

Having a stick in place to enforce compliance three years after the original rule is expected to more firmly move the needle on interoperability in U.S. healthcare.

By Rebecca Pifer • June 28, 2023

FTC proposes updates to merger review that could slow healthcare dealmaking

A new rule proposed by antitrust regulators would ask companies to provide additional information about planned mergers to help the Federal Trade Commission keep pace with increased deal volume and complexity.

By Emily Olsen • June 28, 2023

The AMA’s new president on how abortion restrictions, AI, burnout impact physicians

Newly-elected Jesse Ehrenfeld is taking the reins at the American Medical Association at a time of pressing changes for doctors.

By Emily Olsen • June 28, 2023

AHA ramps up criticism of site-neutral legislation

Site-neutral payments ignore key differences between hospital outpatient departments and physician offices, the hospital lobby argued this week in a new report and briefing on Capitol Hill.

By Susanna Vogel • June 27, 2023